Huang Shih-Ting, Wang Tyng-Guey, Peng Mei-Chih, Chen Wan-Ming, Jao An-Tzu, Tang Fuk Tan, Hsieh Yu-Ting, Ho Chun Sheng, Yeh Shu-Ming
Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.).
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei City, Taiwan (R.O.C.).
Ann Rehabil Med. 2024 Jun;48(3):220-227. doi: 10.5535/arm.230011. Epub 2024 Jun 4.
To construct a prognostic model for unsuccessful removal of nasogastric tube (NGT) was the aim of our study.
This study examined patients with swallowing disorders receiving NGT feeding due to stroke or traumatic brain injury in a regional hospital. Clinical data was collected, such as age, sex, body mass index (BMI), level of activities of daily living (ADLs) dependence. Additionally, gather information regarding the enhancement in Functional Oral Intake Scale (FOIS) levels and the increase in food types according to the International Dysphagia Diet Standardization Initiative (IDDSI) after one month of swallowing training. A stepwise logistic regression analysis model was employed to predict NGT removal failure using these parameters.
Out of 203 patients, 53 patients (26.1%) had experienced a failed removal of NGT after six months of follow-up. The strongest predictors for failed removal were age over 60 years, underweight BMI, total dependence in ADLs, and ischemic stroke. The admission prediction model categorized patients into high, moderate, and low-risk groups for removal failure. The failure rate of NGT removal was high not only in the high-risk group but also in the moderate-risk groups when there was no improvement in FOIS levels and IDDSI food types.
Our predictive model categorizes patients with brain insults into risk groups for swallowing disorders, enabling advanced interventions such as percutaneous endoscopic gastrostomy for high-risk patients struggling with NGT removal, while follow-up assessments using FOIS and IDDSI aid in guiding rehabilitation decisions for those at moderate risk.
构建一个预测鼻胃管（NGT）拔除失败的预后模型是本研究的目的。
本研究对一家地区医院中因中风或创伤性脑损伤而接受NGT喂养的吞咽障碍患者进行了检查。收集了临床数据，如年龄、性别、体重指数（BMI）、日常生活活动（ADL）依赖程度。此外，收集了吞咽训练一个月后根据国际吞咽障碍饮食标准化倡议（IDDSI）在功能性经口摄食量表（FOIS）水平上的提高以及食物种类增加的信息。采用逐步逻辑回归分析模型，使用这些参数预测NGT拔除失败情况。
在203例患者中，53例患者（26.1%）在随访6个月后出现NGT拔除失败。拔除失败的最强预测因素是年龄超过60岁、体重指数偏低、ADL完全依赖以及缺血性中风。入院预测模型将患者分为拔除失败的高、中、低风险组。当FOIS水平和IDDSI食物种类没有改善时，不仅高风险组的NGT拔除失败率高，中风险组的失败率也高。
我们的预测模型将脑损伤患者分为吞咽障碍风险组，对于因NGT拔除困难而处于高风险的患者，可进行诸如经皮内镜下胃造口术等高级干预措施，而使用FOIS和IDDSI进行的随访评估有助于指导中度风险患者的康复决策。
